Most children can be trained to control their bowels between ages 2 and 3 and to control their bladder during the daytime between ages 3 and 4. By age 5, most children can use the toilet alone and manage all aspects of dressing, undressing, urinating or defecating, wiping, flushing, and handwashing.
However, some children have trouble controlling their bladder or bowels. This lack of control is called incontinence. For children who have trouble controlling their bladder, see Urinary Incontinence in Children. For children who have trouble controlling their bowels, see Stool Incontinence in Children.
Recognizing signs of the child's readiness is the key to toilet teaching. Readiness is signaled when the child:
Has dry periods lasting several hours
Wants to be changed when wet or soiled
Shows an interest in sitting on a potty chair or toilet and shows signs of preparing to urinate or defecate
Can place things where they belong and can follow simple commands
Children are usually ready to start training between the ages of 18 months and 30 months. Despite physical readiness to use the toilet, some children may not be emotionally ready. To avoid a lengthy struggle over toileting, it is best to wait until children indicate emotional readiness. When children are ready, they will ask for help in the bathroom or make their way to the potty chair on their own.
The toilet training routine should be consistent among all caregivers. Babysitters, grandparents, and childcare workers should follow the same routine and use the same names for body parts and bathroom acts.
The timing method introduces the child to using the toilet gradually. Children who seem ready are introduced to the potty chair and gradually asked to sit on it briefly while fully clothed. Children are then encouraged to practice taking their pants down, sitting on the potty chair for no more than 5 or 10 minutes at a time, and redressing. Simple explanations are given repeatedly and are reinforced by placing wet or dirty diapers in the potty bowl. Children are also encouraged to practice using the potty whenever they sense the need to go. They should be taught about flushing and handwashing each time they urinate or defecate.
Praise or a reward (such as stickers) is given for successful behavior. Anger or punishment for accidents or for lack of success should be avoided because the teaching process for the child will become negative and overly stressful. Parents should understand and accept that toilet training may take months and that their child may have accidents along the way.
The timing method works well for children who have predictable bowel and urine schedules and who can be placed on the potty chair at their normal time of elimination. It may be better to delay teaching children with unpredictable schedules until they can anticipate the need to visit the potty chair on their own.
Other methods include child-centered toilet training, which involves following the child's cues and pace for toilet training and reward-based methods, which can work rapidly in some children.
A child who resists sitting on the toilet should try again after a meal. If resistance continues for days, postponing the teaching for several weeks is the best strategy. Children who refuse to use the toilet or potty may just not be ready. Giving praise or a reward for sitting on the toilet and producing results is effective. Once the pattern is established, rewards can be given for every other success and then gradually stopped.
Power struggles should be avoided because they often cause setbacks in any progress that has been made and may strain the parent-child relationship.
Previously toilet-trained children may also have more accidents or seem to lose progress that has been made with toilet-training when they are sick or emotionally upset or when they feel the need for more attention, such as when a new sibling arrives. In these situations, parents should try to avoid pressuring their child, can offer rewards, and, if possible, can give their child more care and attention at times when toilet teaching is not involved.
